The Role of Government in “Active Ageing” in Vietnam

Tran Thi Mai OanhHealth Strategy and Policy Institute

Ministry of Health, Vietnam

Vietnam Presentations for “The 11 ASEAN & Japan High Level Officials Meeting (HLOM) on Caring Societies”

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Area: 331,000 km2Population: 90 millions (11/2013)74% people living in rural area

Nguồn: TCTK, Tổng Điều tra DS & Nhà ở 1979, 1989. 1999, 2009 và Điều tra Biến động DS-KHHGD, 2011

Average life expectancy: 73

Traditional culture: multi-generation family - 50% elderlypeople living with children(VHLSS, 2010)

VIETNAM IS IN THE PERIOD OF BECOMING “AGEING POPULATION”

4.7 5.8

6.4

7.1

2009-2012 2012-20201979-1989

65+(%)

1999

4.7

Proportion of the elderly (65+), Vietnam 1979-2020

In 2011: Vietnam becoming

a country with aging population

Year Popu.(millions)

60+

(millions)% 65+

(%)

1979 53,74 3,71 6,9 4,71989 64,38 4,64 7,2 4,71999 76,33 6,19 8,1 5,82009 85,84 7,45 8.68 6,42010 86,75 8,15 9,4 6,82011 87,61 8,65 9,9 7,0

Role of government in active ageing in Vietnam

HealthSecurity Participation

Overall policy framework toward elderly care in Vietnam

Law on the Elderly issued by National Assembly in Nov. 2009 and under law policiesNational action plan on elderly people for 2012-2020Other health related policies:- Law on health care for people for the period 2011-2020 and vision of 2030- Resolution of the Politburo on strengthening PHCDecree 67/2007/ND-CP and Decree 13/2010/ND-CP of the government on social allowance for vulnerable group include the elderly who have no income

Main contents of the elderly care related policies

Heal

thThe elderly’s right in health care

• The elderly are given priority when seeking health care at the health facilities• The elderly ≥ 80 years is followed up health status by CHSs and can received health services at home in the case if needed

Facility services • Health facilities must have separate treatment beds or separate treatment room for the elderly

Health service delivery system for the elderly care

Public sector Private(199.011 beds) (9.611 beds)

1BVLK TW

(5% BV tỉnh cókhoa lão, 10%

khoa lão kết hợptrong khoa nội)

561 District hospitals

(có giường bệnh riêng đièu trịNCT)

150 private hospitals

- 35,000 private practitioners

-39,000 private pharmacies

11.112 TYT xã (78,8% TYT xã KCB BHYT)

96.534 NVYT thôn, bản (>90%)

200 long-terms care facilities for the elderly

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Main contents of the elderly care related policiesSe

curit

yHealth security program • The elderly ≥ 80 years, the

elderly poor and no income are provided free health insurance cards

Income security for the elderly

• Lonely and no income elderly: provided monthly allowance from the government

Main contents of the elderly care related policies

Participation

• There are organizations for the elderly: the Elderly Care Committee at central level, Elderly Association at province level and at the community level, there is village elderly associations (existed in every village) and village elderly clubs.• Addressed important role of the elderly in keeping local political stability and encourage the elderly to actively participate in local community activities.

Challenges in caring for Old people in Vietnam

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Challenges in health service provision at PHC level

Public Private(199.011 beds) (9.611 beds)

39BV TW

382 BV Tỉnh

48 BV ngành

561 BV Huyện

686 PKĐKKV

150 BV tư

-35.000 cơ sở y tế tư nhân

-39.000 cơ sở dược tư nhân

11.112 TYT xã (78,8% TYT xã KCB BHYT)

96.534 NVYT thôn (>90%)

(1) Shortage and low quality of health workforces at grassroot level in providing PHC services: mal-distribution (27-60-80); difficult to attract and sustain health workforces in rural & mountainous areas; lack of knowledge and skills

in providing health services

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Challenges in health service provision at PHC level

Public Private(199.011 beds) (9.611 beds)

39BV TW

382 BV Tỉnh

48 BV ngành

561 BV Huyện

686 PKĐKKV

150 BV tư

-35.000 cơ sở y tế tư nhân

-39.000 cơ sở dược tư nhân

11.112 TYT xã (78,8% TYT xã KCB BHYT)

96.534 NVYT thôn (>90%)

(2) Lack of medicines and medical equipments compared to regulation not adequate enough to provide PHC

services comprehensively with good quality

(3) Budget allocation is in favor of tertiary hospitals and under-funded for PHC

can not follow up health status of the elderly ≥ 80 years

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3.921.8

24.3

46.541.9

26.729.9

5.0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% sủ dung dịch vu % sử dụng quỹ

Xã

Huyện

Tỉnh

TƯ

Challenges in health service provision at PHC levelBV Công lập

39BV TW

382 BV Tỉnh

48 BV ngành

561 BV Huyện

686 PKĐKKV

150 BV tư

- 35.000 cơ sở y tế tư nhân

-39.000 cơ sở dược tư nhân11.112 TYT xã (78,8% TYT xã KCB BHYT)

96.534 NVYT thôn (>90%)

- 63 TTYTDP tỉnh- 63 Chi cục Dân số KHHGĐ- 62 TT Phòng chống HIV/AIDS- 63 Chi cục ATVSTP- 63 TT SKSS; 63 TTTT GDSK

- TTYT Huyện (BV huyện và Y tế dự phòng)- TT Dân số KHHGĐ Huyện (62/63 tỉnh)

(4) Wide health service delivery network but lack of integration in providing preventive

and curative services, between health programs. Lack of coordination between

health facilities at higher levels and grassroot health facilities

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Low coverage of social allowance (50%)Low rate of allowance

(21% of the minimum living standard and 34% of the minimum food consumption)

No allowance 49,3%

Monthly allowance

receivers 12,4%

Pension receivers, 22,1%

Monthly allowance for elderly:16,3% , 0

30% elderly without health insurance

Challenges in caring for old people

Social Security fund is at risk of breaking in the futureDue to:- The benefit rate is higher than the contribution rate (contribute 16-22%,

benefit 75%) and Vietnam applies PAYG system with defined benefit manged by the government.

- Limited number of participating people in social insurance scheme: can involve only 20% labor force; low % of people involved in voluntary social insurance scheme due to high premium compared to income and workers aged >45 yrs (40 yrs for female) can not participate because participation duration is not adequate.

- Compliance of private enterprises in social insurance scheme for their labor forces is very low.

According to ILO, social security fund would probably exshausted by 2030

Challenges in caring for old people

Long-term care facilities is limited in terms of quantity: 200

Caring for the elderly is mainly responsible by the family but lack of knowledge on health care for the elderly among caregivers

Thank you for your attention!